慢性心房颤动

• What are the effects of pharmacological interventions to prevent atrial fibrillation after heart surgery?
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• How does amiodarone compare with placebo for the prevention of sudden cardiac death in at-risk adults?
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• How does catheter ablation compare with drug treatment for improving outcomes in people with paroxysmal and persistent atrial fibrillation?
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• What are the effects of ablation for people with non-paroxysmal atrial fibrillation?
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• What are the benefits and harms of antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation?
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• How do factor Xa inhibitors compare with warfarin for prevention of cerebral and systemic embolism in people with atrial fibrillation (AF)?
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• What are the effects of non-pharmacological interventions to prevent atrial fibrillation after heart surgery?
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证据评分

证据 B 恢复窦性心律：有中等质量的证据显示导管射频消融术治疗阵发性和持续性心房颤动的一年成功率（定义为不使用抗心律失常药物的情况下维持窦性节律）为52%，总体成功率(定义为同时使用抗心律失常药物)为75.9%。[108]Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005 Mar 8;111(9):1100-5.http://circ.ahajournals.org/content/111/9/1100.fullhttp://www.ncbi.nlm.nih.gov/pubmed/15723973?tool=bestpractice.com 777个中心的调查表明，导管消融术有5.9%的手术并发症的发生率，包括心脏填塞(1.2%)、血栓性卒中(0.9%)、肺静脉狭窄(1.6%)及食管瘘。 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

恢复窦性心律：有中等质量的证据显示导管射频消融术治疗阵发性和持续性心房颤动的一年成功率（定义为不使用抗心律失常药物的情况下维持窦性节律）为52%，总体成功率(定义为同时使用抗心律失常药物)为75.9%。[108]Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005 Mar 8;111(9):1100-5.http://circ.ahajournals.org/content/111/9/1100.fullhttp://www.ncbi.nlm.nih.gov/pubmed/15723973?tool=bestpractice.com 777个中心的调查表明，导管消融术有5.9%的手术并发症的发生率，包括心脏填塞(1.2%)、血栓性卒中(0.9%)、肺静脉狭窄(1.6%)及食管瘘。

证据 C 临床治愈：有较低质量的证据表明“切割-缝合”CoxIII型迷宫手术治疗持续性和永久性心房颤动患者的15年成功率为95%(1年成功率为99%)。[104]Damiano RJ Jr, Gaynor SL, Bailey M, et al. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. J Thorac Cardiovasc Surg. 22003 Dec;126(6):2016-21.http://www.ncbi.nlm.nih.gov/pubmed/14688721?tool=bestpractice.com 手术死亡率是2%，且因潜在的窦房结病变，有19%的患者术后需安装起搏器。[104]Damiano RJ Jr, Gaynor SL, Bailey M, et al. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. J Thorac Cardiovasc Surg. 22003 Dec;126(6):2016-21.http://www.ncbi.nlm.nih.gov/pubmed/14688721?tool=bestpractice.com CoxIV型迷宫手术为改良的微创手术，同时行双房射频消融和左心耳缝闭术。 在一个多种类型的心房颤动人群中，CoxIV型迷宫手术1年的成功率为91%。[105]Melby SJ, Kaiser SP, Bailey MS, et al. Surgical treatment of atrial fibrillation with bipolar radiofrequency ablation: mid-term results in one hundred consecutive patients. J Cardiovasc Surg (Torino). 2006 Dec;47(6):705-10.http://www.ncbi.nlm.nih.gov/pubmed/17043619?tool=bestpractice.com 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

临床治愈：有较低质量的证据表明“切割-缝合”CoxIII型迷宫手术治疗持续性和永久性心房颤动患者的15年成功率为95%(1年成功率为99%)。[104]Damiano RJ Jr, Gaynor SL, Bailey M, et al. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. J Thorac Cardiovasc Surg. 22003 Dec;126(6):2016-21.http://www.ncbi.nlm.nih.gov/pubmed/14688721?tool=bestpractice.com 手术死亡率是2%，且因潜在的窦房结病变，有19%的患者术后需安装起搏器。[104]Damiano RJ Jr, Gaynor SL, Bailey M, et al. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. J Thorac Cardiovasc Surg. 22003 Dec;126(6):2016-21.http://www.ncbi.nlm.nih.gov/pubmed/14688721?tool=bestpractice.com CoxIV型迷宫手术为改良的微创手术，同时行双房射频消融和左心耳缝闭术。 在一个多种类型的心房颤动人群中，CoxIV型迷宫手术1年的成功率为91%。[105]Melby SJ, Kaiser SP, Bailey MS, et al. Surgical treatment of atrial fibrillation with bipolar radiofrequency ablation: mid-term results in one hundred consecutive patients. J Cardiovasc Surg (Torino). 2006 Dec;47(6):705-10.http://www.ncbi.nlm.nih.gov/pubmed/17043619?tool=bestpractice.com